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Chemotherapy Remains Backbone in Non-Driver Lung Adenocarcinoma

Gina Columbus @ginacolumbusonc
Published: Saturday, Apr 29, 2017

Over the past few years, there has been an explosion of therapeutic advances for patients with non–small cell lung cancer (NSCLC) with molecular abnormalities or high levels of PD-L1 expression.

State of the Science Summit on Advanced Non–Small Cell Lung Cancer. In an interview at the meeting, she shared insight on research aiming to improve platinum-based doublet therapy and the role of chemotherapy for non-driver adenocarcinoma in the future.

OncLive: You spoke about patients with stage IV lung adenocarcinoma without driver mutations. What is important to highlight about these patients?

Fidler: This talk was about systemic treatment of NSCLC in patients without drivers and without a high expression of the PD-L1 protein, which are still the bulk of patients who are coming through the door. We focused on how we got to platinum-doublet therapy as a cornerstone and ways to improve upon it. There were also studies on maintenance strategies, adding angiogenic agents, and studies adding EGFR-targeted therapies to the backbone of chemotherapy. 

In what ways are we improving upon platinum-doublet therapy?

If you look at the survival comparisons between 1 platinum doublet and another, we have made little progress and survival curves are overlapping. However, there are some subtleties and toxicities [between them], and there may be some subtleties in patient selection. 

For example, nab-paclitaxel (Abraxane) may have a higher response rate in squamous cell patients. We hear a little bit about why these platinum doublets are not equal and how can we tease them out a little bit. 

What do we see with the addition of angiogenesis inhibitors?

People have tried to improve upon the platinum-doublet regimen, and the first big improvement was published several years ago, which was adding bevacizumab to carboplatin/paclitaxel. That made great news at the time and generated great excitement, because the addition of the antiangiogenic/anti-VEGF agent improved the median overall survival (OS), progression-free survival, the 1-year OS, and we saw numbers with a median survival of greater than 1 year which we had not seen in these studies. 
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Online CME Activities
TitleExpiration DateCME Credits
Advances in™ Therapies for Patients With ALK-Positive Lung Cancers: More Options…More Decisions…Better OutcomesAug 30, 20191.5
Oncology Briefings™: Treating Advanced NSCLC Without Actionable MutationsAug 30, 20191.0
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